Nutrition Publications - Friedman School & HNRCA

Public Impact Initiative: Why Now?

Momentum is building in favor of healthier federal food programs. The media, the food industry, and a vanguard of policymakers are all beginning to recognize the link between poor diets, chronic illness and health care costs. Many Americans, young and old, urban and rural, traditional and progressive, also recognize that the current food system is broken. The window for meaningful change is opening, and the time for action is now.

We’ve focused on a few key areas where we believe small changes can have the greatest impact. Our recommendations toward healthier, more effective US food and wellness policies are centered around Healthcare reform, healthier SNAP, food and nutrition innovation, and worksite wellness.

Healthcare Reform: Medicare and Medicaid

Discussing healthcare reform without focusing on food is a major omission, helping to explain why the US lags behind other wealthy nations in health metrics and why healthcare costs cannot be brought under control. The treatment of diet-related major chronic diseases is estimated to account for the majority of US healthcare expenses overall, including Medicare spending and Medicaid spending.

New research from Tufts suggests:

Providing a 20 percent incentive for fruit and vegetable purchases to Medicaid and Medicare beneficiaries, for example through a new adapted EBT card, is highly cost-effective, costing less for comparable health gains than many federally-approved medical interventions such as drug treatment of hypertension or use of statin drugs for primary prevention of heart disease.

A broader 20 percent incentive for fruits, vegetables, whole grains, nuts, fish, and plant-based oils would lead to even greater health gains and be even more cost-effective.

Healthier SNAP

SNAP has been shown to lead to positive health outcomes: In a study of more than 4,000 low-income adults, participation in SNAP was associated with about $1400 per person per year lower healthcare expenditures, compared to Americans of similar income not on SNAP. However, the diets and health outcomes of SNAP participants could still benefit from improvement.

New research from Tufts suggests:

Extending a 30 percent F&V incentive to all SNAP participants meets traditional cost-effectiveness threshold over 10 years and would be highly cost-effective over a lifetime.

A combined incentive/disincentive program that incentivizes healthier eating in SNAP across more food categories while still preserving choice produces even larger health gains and is even more cost-effective from a government affordability perspective, with high cost-effectiveness at 5 years and net cost-savings at 20 years.

Food and Nutrition Innovation

Thanks to ongoing advances in nutrition science, we continue to discover exactly what humans should eat to promote optimum health outcomes. However, many crucial questions remain, and far too little money is invested in nutrition research. Across all federal agencies, the US government estimates that total funding for nutrition research is about $1.5 billion/year. In comparison, about $1 billion/year is spent for US advertising of candy, while nearly $50 billion/year is spent by US consumers on candy. A concerted national effort is needed to substantially increase federal funding for nutrition research.

Areas to investigate:

Government incentives would be valuable to stimulate greater food industry research and development of healthy foods. For federal budget neutrality, potential disincentives could be added (e.g. removal of tax deductions) for development and marketing of unhealthy foods.

Considering the Farm Bill, a national program to subsidize the cost of fruits and vegetables by 10 percent could save 150,000 lives over 15 years.

Considering the FDA, a government-led voluntary industry initiative to reduce salt in packaged foods by about three grams per day could prevent tens of thousands of cardiovascular deaths per year, while saving between $10 and $24 billion in healthcare costs annually.

Worksite Wellness

Worksite wellness programs really do pay off: Reducing employee health risks such as high glucose and blood pressure by just 1 percent could save employers $83 to $103 per person annually. Every dollar that employers spend on wellness programs generates about $3.27 in lower medical costs and $2.73 in less absenteeism.

Areas to investigate:

Many worksite wellness programs currently incentivize physical activity, e.g., through subsidizing gym memberships. Similar programs should be encouraged for incentivizing healthier food purchases, e.g., through existing technology platforms that are currently offered by some American worksite wellness, health insurance, and life insurance programs.